Dequalinium chloride, also known by the brand-name Fluomizin, is an antimicrobial agent that has broad activity against fungi and bacteria when applied vaginally. Dequalinium chloride has low absorbency, making it a useful vaginal treatment option for infections, either bacterial or fungal in nature. Dequalinium chloride works against gram-positive and gram-negative bacteria, yeasts, and protozoa – all relevant vaginal infection-related microbes (see list below).
Dequalinium chloride can be used to treat straightforward vaginal infections or those which are uncertain in terms of diagnosis. Resistance of pathogens to dequalinium chloride is unlikely because of the way the substance works.
While dequalinium chloride has been tested in the lab against almost everything, the lab and test tubes present a very different environment to the real-life vagina, which has crevices, biofilms, and more bacteria at work. The treatment can be very effective against planktonic bacteria, but there is no research into how dequalinium chloride affects biofilms. If you need to do a biofilm treatment, at the moment we recommend following the Four-pronged Approach in Killing BV, which will work for biofilms of all kinds.
Dequalinium chloride is effective against many common vaginal pathogens:
- Atopobium vaginae (anaerobic gram-positive)
- Bacteroides spp. (anaerobic gram-negative)
- Bacteroides fragilis (anaerobic gram-negative)
- Bacteroides vulgatus (anaerobic gram-negative)
- Candida spp. (yeast)
- Candida albicans (yeast)
- Candida glabrata (yeast)
- Candida krusei (yeast)
- Enterobacter spp. (aerobic gram-negative)
- Enterococcus faecalis (aerobic gram-positive)
- Escherichia coli (aerobic gram-negative)
- Fusobacteria (anaerobic gram-negative)
- Gardnerella vaginalis (anaerobic gram-positive)
- Klebsiella spp. (aerobic gram-negative)
- Lactobacillus spp. (aerobic gram-positive)
- Listeria monocytogenes (anaerobic gram-positive)
- Peptostreptococcus (anaerobic gram-positive)
- Porphyromonas spp. (anaerobic gram-negative)
- Prevotella spp. (anaerobic gram-negative)
- Prevotella bivia (anaerobic gram-negative)
- Prevotella disiens (anaerobic gram-negative)
- Prevotella intermedia (anaerobic gram-negative)
- Porphyromonas asaccharolytica (anaerobic gram-negative)
- Pseudomonas spp. (aerobic gram-negative)
- Serratia spp. (aerobic gram-negative)
- Staphylococcus aureus (aerobic gram-positive)
- Streptococcus agalactiae (Group B Streptococci, aerobic gram-positive)
- Streptococcus pyogenes (Group A Streptococci, aerobic gram-positive)
Naturally dequalinium chloride-resistant bacteria
- Proteus mirabilis (facultatively anaerobic, gram-negative)
- Chlamydia trachomatis (aerobic gram-negative)
- Trichomonas vaginalis (parasitic protozoa)
What is dequalinium chloride and how does it work?
Dequalinium chloride is an ammonium salt, which probably doesn’t mean much to you, and nor does it particularly matter. Dequalinium chloride is not an antibiotic and is available over the counter in some countries. This substance has been used for a while now in lozenges to kill throat bacteria involved in sore throats.
Dequalinium chloride works to kill microbes by increasing cell permeability, stopping the microbe’s enzyme activity. Once microbes lose their magical enzymatic powers, they quickly lose their ability to survive. It may affect the microbe’s osmotic system, cell metabolism, energy production, and protein synthesis.
In the lab, the bactericidal (germ-killing) and fungicidal (fungus-killing) powers occurred within an hour and no resistance has been reported from any lab studies or clinical trials.
Orally and vaginally, absorption rates of dequalinium chloride are low, and therefore toxicity isn’t considered an issue. Animal studies have found no concerns for use during pregnancy.
About vaginal Fluomizin tablet treatments
Fluomizin tablets quickly disintegrate in the vagina and the active substance spreads throughout the vagina. Once vaginal secretions dissolve the tablet, the dose in the vagina is from between four and eight times higher than what is required to inhibit the least susceptible bacteria (minimal inhibitory concentration, MIC).
Typically you would insert the tablets (or other product, however that is presented) deep into the vagina. The typical dose is 10mg, but how this is applied will depend on your infection and how you respond.
Biofilms may complicate the infection, and longer treatment doses may be required and treatment may fail due to this. If your condition comes with biofilms as a feature, it may be advisable to double the dose (10mg morning and before bed), and double the treatment time to 12 days.
Other products that contain dequalinium chloride
- Dequadin 10mg vaginal pessaries
- Dequavagyn 50mg controlled release ovules (8-10-day treatment)
- Dequavagyn 20mg/10g cream, controlled release (8-10-day treatment)
- Oestro-Dequavagyn 20mg/10g cream with 0.15mg oestriol (E3), controlled release (8-10-day treatment)
- Oestro-Dequavagyn 20mg/10g cream with 2mg oestriol (E3), controlled release (8-10-day treatment)
- Gyken ovules 20mg
- Erosept vaginal foam 100mg/100g
Possible side-effects of dequalinium chloride
Over 3,000 women so far have been in clinical trials of dequalinium chloride, with the following side-effects observed:
- Well tolerated overall
- No serious adverse events recorded
- Local reaction
- Vaginal discharge
Dequalinium chloride safety in pregnancy
Many studies have tested dequalinium chloride in pregnant women with no adverse effects on pregnancy or the health of the foetus/baby.
Where to buy dequalinium chloride
You can buy Fluomizin online, sometimes on eBay, but otherwise from European pharmacy stores. It is not available over the counter in most places outside the EU. It is relatively inexpensive, but ensure you buy the right dose for your vaginal infection – you don’t want to get to the end of one six-pack and realise you needed twice as many tablets to double your dose.
Postage outside of Europe is costly due to tracking. Look online for the best price including shipping – there are many suppliers, as it is freely available in Europe, but you won’t find it on Amazon or iHerb. You will need to look harder, but there are many suppliers.
If you are tight on cash, but have a friend in Europe who could do you a favour, it’s a good idea to ask them to pick you up a packet or two, and post them via normal post for a few dollars. The product itself is not expensive, about 15 euros (US$19).
A Canadian company, Duchesnay, has bought the rights to sell Fluomizin locally in North America, but these applications can take some time, being submitted in late 2016. Australians, New Zealanders and Asians face exorbitant shipping costs. Over time, more countries will get distribution rights to this product, so watch this space.
Research into vulvovaginal infections and dequalinium chloride (DQC)
Study #1 – Weissenbacher, 2012, bacterial vaginosis, Fluomizin vaginal tablets vs clindamycin two per cent cream, six days
- At week 1, cure rates were 81.5 per cent for DCQ and 75 per cent in clindamycin group.
- At week 4, cure rates were 80 per cent for DCQ and 78 per cent in clindamycin group.
- Well tolerated
Study #2 – Radzinsky et al, 2011, non-specific vaginitis, Fluomizin vaginal tablets six days versus standard anti-infective treatment, with Gynoflor restoration afterwards
- Fluomizin group saw 78 per cent cure
- Standard anti-infective treatment saw 77 per cent cure
Study #3 – Dankovich and Gopchuk, 2006, abnormal vaginal flora, Fluomizin vaginal tablets, six days, pre-surgery preventative
- Out of 45 women undergoing surgery, just one had complications after surgery
- Vaginal flora became healthy in 44 women
- No adverse effects
Study #4 – Grishchenko et al, 2006, bacterial vaginosis in pregnant women, Fluomizin versus povidone iodide vaginally
- Resulted in favourable conditions for pregnancy and healthy baby
Study #5 – Grischenko et al, 2006, mixed infection, Flugomizin versus chlorhexidine bigluconate
- Fluomizin cure rate was 97 per cent
- Chlorhexidine bigluconate cure rate was 66 per cent
Study #6 – Demina et al, 2005, bacterial vaginosis and opportunistic flora vaginitis, Fluomizin versus povidone iodine vaginally
- Vaginal flora recovery in all pregnant women of one group after one treatment
- Vaginal clearance seen in 92 per cent of women
- No Candida albicans seen after Fluomizin
Study #7 – Petersen, 2002, bacterial vaginosis, yeast infections and trich, Fluomycin vaginal tablets versus povidone iodine vaginally
- Fluomizin group saw decrease in symptoms from 5.13 to 1.33
- BV: Fluomizin group cure rate was 96 per cent; povidone iodine group cure rate was 82 per cent
- Yeast infections: symptom decrease from 6.5 to 1.1
- Aerobic vaginitis: symptoms decreased from 5.0 to 1.3
- Some local irritation in some women
Study #8 – Schmidt, 2000, bacterial vaginosis, trich, yeast and flora imbalance in pregnant women, Fluomycin 10mg DQC vaginally for six days
- Distinct improvement in all documented clinical symptoms
- Mendling W, Weissenbacher ER, Gerber S, Prasauskas V, Grob P. Use of locally delivered dequalinium chloride in the treatment of vaginal infections: a review. Archives of Gynecology and Obstetrics. 2016;293:469-484. doi:10.1007/s00404-015-3914-8.
- Della Casa V1, Noll H, Gonser S, Grob P, Graf F, Pohlig G. Antimicrobial activity of dequalinium chloride against leading germs of vaginal infections. Arzneimittelforschung. 2002;52(9):699-705.